ISOLATED VOLUNTARY FACIAL PARESIS DUE TO PONTINE ISCHEMIA

We describe a patient with isolated voluntary facial paresis due to a unilateral lacunar lesion in the contralateral mediodorsal middle base of the pens. Transcranial magnetic stimulation confirmed the involvem ent of supranuclear corticofacial tract fibers and sparing of the cort icolingual and corticospinal connections. This observation demonstrate s that the fibers conveying voluntary orofacial activation descend med iodorsally at the level of the middle pens and that the fibers conveyi ng emotional activation may be assumed to converge below this level.